Filling the health human resource gap through public-private partnership: What we know from Bangladesh

by 12th Oct 2018
Champa Rani, a Private Community Skilled Birth Attendant, provides Sharker with ante-natal care in Sunamganj Champa Rani, a Private Community Skilled Birth Attendant, provides Sharker with ante-natal care in Sunamganj

Today, at the 5th Global Symposium on Health Systems Research in Liverpool, UK, I’m presenting key learning from CARE’s highly successful and Global Good Award winning Private Community Skilled Birth Attendant (P-CSBA) programme in Bangladesh, part of CARE and GSK’s global partnership to train and support frontline health workers. Here are the top-line findings – and what they tell us about the potential of public-private partnerships.

The learning is drawn from a forthcoming research report ‘Filling the human resource gap through public-private partnership: Can private, community-based skilled birth attendants improve maternal health service utilization and health outcomes in Sunamganj Bangladesh?’ The report will share details of how this model combines clinical and social entrepreneurship capacity building with robust monitoring, supervision and support from the public sector, and report on changes in service utilisation and health outcomes from baseline to three years post-baseline.

An under-served community that is underwater for half the year

Sunamganj, home to over 24 million people, is a remote and under-served region within Sylhet Division characterised by wetlands and frequent flooding.

The global shortage of health service providers is a critical barrier to the delivery of the health services needed to reach universal health coverage and achieve the Sustainable Development Goals. In Sylhet Division, this shortage is acute, with fewer than four skilled providers per 10,000 people and just 38% of births assisted by a skilled attendant.

Women are forced to seek health care from non-qualified providers in the informal sector, resulting in high out-of-pocket costs for health. Clients face no other option than to receive poor quality services from unskilled providers at high costs.

Significant health improvements

In search of an innovative solution to this challenge, CARE formed a public-private partnership with the Government of Bangladesh to design and implement the Private Community Health Worker Initiative.

CARE’s research has compared data collected at baseline and three years’ post-baseline, and revealed significant improvements in both birth planning practices and the use of key maternal health services.

Results of the mid-line survey indicate a dramatic increase in the proportion of respondents reporting skilled attendance at birth from 15% at baseline to 30% at follow-up. These changes seemed to be driven by increases in the proportion of births attended by doctors, nurses, midwives, and indeed P-CSBAs (Private Community Skilled Birth Attendants).

CARE is in the process of analysing these data and forthcoming endline survey data to more rigorously evaluate this model.

The potential of private-public partnerships

CARE’s findings contribute to the larger body of evidence suggesting that private-sector approaches, when coupled with robust efforts to strengthen and collaborate with the public sector, can work successfully to deliver services in under-served communities like Sunamganj.

The success of this model lends credence to the growing appreciation that reaching our development targets will require governments to work in partnership with private sector actors, and highlights the scaling potential of private-public partnerships as we drive towards universal health coverage.

CARE Kenya and CARE India also presenting at HSR18

Kizito Mukhwana, from CARE Kenya / Options Kenya, is presenting on engaging communities through Community Score Cards to improve social accountability and health service delivery; sharing lessons learned from the MANI (Maternal and Newborn Improvement) project in Bungoma County, Kenya. The 2013 introduction of free maternal care in Kenya has led to increased demand for maternal health services and is an important step towards universal health coverage. The MANI project aims to strengthen core health systems and increase survival of mothers and newborns by enabling poor women to access affordable and quality health services.

Dr Aboli Gore from CARE India Solutions for Sustainable Development is also presenting on CARE’s Bihar Technical Support programme, a 2011-2021 initiative supported by the Bill & Melinda Gates Foundation and in partnership with the Health and Social Welfare Departments of the Government of Bihar, India, to reduce rates of maternal, newborn and child mortality and malnutrition and improve immunisation rates and reproductive health services (including family planning). Dr Aboli Gore’s presentation focuses on facility preparedness and its role in the success of an innovative state-wide onsite nurse-midwife mentoring initiative.

Anne Laterra

Anne Laterra joined CARE’s Sexual Reproductive Health and Rights team in 2015 and in her current role as Technical Advisor for Evaluation and Learning, she works with colleagues across the confederation to ensure that CARE is producing evidence and learning that will propel the organisation towards its ambitious goals. This includes setting of strategic direction for SRHR evidence generation and learning efforts and supporting a wide variety of activities including evaluation design, data analysis, and partnership development.

In this capacity she has worked across a variety of projects and initiatives, including a project in Malawi to adapt one of CARE’s social accountability approaches, CARE’s Community Score Card, to the prevention of mother-to-child transmission of HIV context; and Inspiring Married Adolescent Girls to Imagine New Empowered Futures (IMAGINE), a learning project to test a holistic intervention package designed to ensure the healthy timing of first pregnancies among adolescent girls in Bangladesh and Niger.

Anne holds a bachelor’s degree from George Washington University and a master’s degree in public health from Emory University.